Overview

Aortic stenosis is when one of the valves in your heart is narrowed.

This means the heart cannot easily pump blood around your body and can cause you to feel:

• short of breath
• chest pain
• dizzy when exercising, which can cause fainting

The extra force needed to pump blood through this narrowed valve also causes strain on the heart, which can lead to fluid on the lungs, swollen ankles and eventually heart muscle weakness.

If untreated, aortic stenosis will usually get worse over time.

You might be treated with a transcatheter aortic valve implantation (TAVI).

A TAVI is a procedure where a new valve is put inside the narrowed aortic valve in your heart. This usually performed under local anaesthetic.

This treatment can improve how well your heart works. This can help with your symptoms, give you a better quality of life and potentially increase your life expectancy.

TAVI assessment

If you have aortic stenosis, tests will be done to check if a TAVI is the best treatment for you.

Not everyone can have a TAVI. We need to check that your heart and blood vessels are suitable. We call this stage the TAVI assessment. 

If the assessment shows you can have the procedure, you can decide if you want to have this treatment or not. It is important to remember that aortic stenosis is a serious condition, and it is likely that your symptoms will progress over time.

If you decide to have this treatment, a member of your heart team will contact you with the details of your hospital appointment for the TAVI procedure. 

Read more about having the TAVI assessment.

TAVI procedure

A TAVI is usually performed under local anaesthetic and takes 1 to 2 hours. A thin tube (catheter) is used to implant a new valve in your heart. This is artificial and made from metal and tissue from pig or cow.

You'll need to stay in hospital for 1 to 2 days after the procedure, but this might be longer.

Read more about having a TAVI.

Risks of having a TAVI

As with any medical procedure there are certain risks involved when having a TAVI. All the potential risks will be fully explained to you by your heart team.

The risks might include:

• heart rhythm abnormalities (arrhythmias), this occurs in 10% to 20% of cases
• bleeding, bruising or pain at the wound site
• damage to an artery, which happens in 5% of cases. If this happens you might need surgery or a percutaneous repair
• a moderate to severe leaky valve, this happens in 5% of cases
• a slow heart rate, which might need a permanent pacemaker. This happens in 5% to 10% of cases
• stroke, this happens in about 3% of cases (3 in 100 people)
• kidney injury, this happens in about 3% of cases (3 in 100 people)
• an infection
• a heart attack, this happens in less than 1% of cases (1 in 100 people)
• allergy to the X-ray dye used during the procedure
• needing open heart surgery, this happens in less than 1% of cases (1 in 100 people)

In rare occasions, problems with the device might lead to death. This could be due to one or a combination of the above risks.

Please speak to the nurse or doctor caring for you if you have any questions or concerns.

Other treatment options

Aortic valve replacement

Another treatment option for aortic stenosis is surgical aortic valve replacement, where the valve is removed and replaced.

This is open heart surgery, which is more invasive than TAVI and can be more risky, particularly if you have other illnesses which increase your risk when having a general anaesthetic.

If you've been referred for a TAVI, it might be that you are at too great a risk for open heart surgery and it has already been agreed that this will not be an option for you.

Balloon aortic valvuloplasty (BAV) 

This will stretch open your aortic valve, which can help your symptoms for 3 to 6 months. However, after this time the valve will narrow again and your symptoms will return. This will not improve your life expectancy.

Medicines

Aortic stenosis cannot be treated with medicine. Medicine can help some symptoms, but it will not fix the diseased valve.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the TAVI procedure, you will be asked to sign a consent form. Staff will explain all the risks, benefits and other options before they ask you to sign a consent form to say that you agree to have the treatment and you understand what it involves.

If at any time there is anything you do not understand, or if you need more time to think about the procedure, please tell your heart team, even if this is after signing the consent form. It is your decision to have the procedure, and your wishes will be respected at all times.

Follow-up appointments

We'll make arrangements for you to come back for an outpatient clinic appointment, usually within 4 months after your discharge. Sometimes we might ask you to have an echocardiogram (ECG) at this appointment. 

You might be asked back for another follow-up appointment several months or a year later.

If you were originally referred from another hospital you might be discharged to your local cardiologist for continued monitoring.

Information and support

British Heart Foundation (BHF)

Funds research into all heart and circulatory diseases and the things that cause them. The website has a lot of helpful information about tests for heart conditions, heart valve disease, caring for someone with a heart condition and cardiac rehabilitation.

British Heart Valve Society 

A professional group affiliated to the British Cardiovascular Society. It includes people of all disciplines interested in heart valve disease with representation from patients as well. It aims to improve the care of people with valve disease through educational and training programmes, information and by defining standards of care.

Heart Valve Voice

A collection of people with real experiences of heart valve disease, including a multi-disciplinary group of experts in the field (cardiologists, cardiac surgeons, GPs), cardiac patient societies, and patients themselves.